Psychological analysis of women’s experiences of late pregnancy termination for fetal anomaly

Abstract

AIM: The aim of this study was to conduct a psychological analysis and summarize information on women’s experiences of late pregnancy termination for fetal anomaly.

MATERIALS AND METHODS: The study included 105 patients aged 19 to 43 years who experienced late pregnancy termination for fetal anomaly after 22 weeks of gestation and who received psychological support during their stay in the maternity hospital. The method of data collection involved structured clinical interview with subsequent analysis and summarizing the information received. The data obtained were compared with the literature, thus leading to a conclusion about long-term psychological consequences after late pregnancy termination.

RESULTS: The general psychological patterns of women’s experiencing of several consequential steps of late pregnancy termination were revealed: during the primary diagnosis, in the decision-making process, during the feticide procedure, during delivery, and in the postpartum period. The tasks of psychological support were formulated; the types of reasons for termination decision were described; the key influence of the psychological status of the fetus on the subjective character of experience was determined. The analysis of foreign issues was made and faraway traumatic consequences of late pregnancy termination for the woman and her family were depicted.

CONCLUSIONS: Late pregnancy termination is a traumatic choice for a woman and her family and it has medical, psychological, ethical and legal contexts. Psychological maintenance can optimize the patient’s contact with the medical staff during her stay in the maternity hospital. Psychologically conceived experience ensure a constructive attitude towards the future pregnancy and its positive conditions.

Keywords

late pregnancy termination / fetus anomaly / psychological experience / feticide

References

[1] Robinson M, Baker L, Nackerud L. The relationship of attachment theory and perinatal loss. Death Stud. 1999;23(3):257−270. DOI: 10.1080/074811899201073

[2] Robinson M., Baker L., Nackerud L. The relationship of attachment theory and perinatal loss // Death. Stud. 1999. Vol. 23. No. 3. P. 257−270. DOI: 10.1080/074811899201073

[3] White-van Mourik MC, Connor JM, Ferguson-Smith MA. The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality. Prenat Diagn. 1992;12(3):189−204. DOI: 10.1002/pd.1970120308

[4] White-van Mourik M.C., Connor J.M., Ferguson-Smith A. The psychosocial sequelae of a second-trimester termination of pregnancy for fetal abnormality // Prenat. Diagn. 1992. Vol. 12. No. 3. P. 189−204. DOI: 10.1002/pd.1970120308

[5] Davies V, Gledhill J, McFadyen A, et al. Psychological outcome in women undergoing termination of pregnancy for ultrasound-detected fetal anomaly in the first and second trimesters: a pilot study. Ultrasound Obstet Gynecol. 2005;25(4):389−392. DOI: 10.1002/uog.1854

[6] Davies V., Gledhill J., McFadyen A. et al. Psychological outcome in women undergoing termination of pregnancy for ultrasound-detected fetal anomaly in the first and second trimesters: a pilot study // Ultrasound. Obstet. Gynecol. 2005. Vol. 25. No. 4. P. 389−392. DOI: 10.1002/uog.1854

[7] Rakitina E. Issledovanie psikhologicheskogo statusa zhenshchin, perenesshikh meditsinskiy abort na razlichnykh srokakh beremennosti po raznym pokazaniyam. Perinatal’naya psikhologiya i psi-khologiya roditel’stva. 2012;(3):24–34. (In Russ.)

[8] Ракитина Е. Исследование психологического статуса женщин, перенесших медицинский аборт на различных сроках беременности по разным показаниям // Перинатальная психология и психология родительства. 2012. № 3. С. 24–34.

[9] Brutman VI, Radionova MS. Formirovanie privyazannosti materi k rebenku v period beremennosti. Voprosy psikhologii. 1997;(6):38−47. (In Russ.)

[10] Брутман В.И., Радионова М.С. Формирование привязанности матери к ребенку в период беременности // Вопросы психологии. 1997. № 6. C. 38−47.

[11] Kopyl OA, Bazhenova OV, Baz LL. Vydelenie faktorov i usloviy psikhologicheskogo riska dlya budushchego razvitiya rebenka. Sinaps. 1994;(5):15−28. (In Russ.)

[12] Копыл О.А., Баженова О.В., Баз Л.Л. Выделение факторов и условий психологического риска для будущего развития ребенка // Синапс. 1994. № 5. С. 15−28.

[13] Stern DN, Bruschweiler-Stern N. The birth of a mother. N.Y.: Basic Books; 1998.

[14] Stern D.N., Bruschweiler-Stern N. The birth of a mother. N.Y.: Basic Books, 1998.

[15] Blokh ME. Perezhivanie utraty obraza rebenka v situatsii vyyavleniya porokov razvitiya ploda. Zhurnal akusherstva i zhenskikh bolezney. 2015;64(Suppl):17−18. (In Russ.)

[16] Блох М.Е. Переживание утраты образа ребенка в ситуации выявления пороков развития плода // Журнал акушерства и женских болезней. 2015. Т. 64. Cпецвып. С. 17−18.

[17] Côté-Arsenault D, Denney-Koelsch E. “Have no regrets:” Parents’ experiences and developmental tasks in pregnancy with a lethal fetal diagnosis. Soc Sci Med. 2016;154:100−109. DOI: 10.1016/j.socscimed.2016.02.033

[18] Côté-Arsenault D., Denney-Koelsch E. “Have no regrets:” Parents’ experiences and developmental tasks in pregnancy with a lethal fetal diagnosis // Soc. Sci. Med. 2016. Vol. 154. P. 100−109. DOI: 10.1016/j.socscimed.2016.02.033

[19] Lalor J, Begley CM, Galavan E. Recasting hope: a process of adaptation following fetal anomaly diagnosis. Soc Sci Med. 2009;68(3):462−472. DOI: 10.1016/j.socscimed.2008.09.069

[20] Lalor J., Begley C.M., Galavan E. Recasting Hope: a process of adaptation following fetal anomaly diagnosis // Soc. Sci. Med. 2009. Vol. 68. No. 3. P. 462−472. DOI: 10.1016/j.socscimed.2008.09.069

[21] DiMiceli-Zsigmond M, Williams AK, Richardson MG. Expecting the unexpected: perspectives on stillbirth and late termination of pregnancy for fetal anomalies. Anesth Analg. 2015;121(2):457−464. DOI: 10.1213/ANE.0000000000000785

[22] DiMiceli-Zsigmond M, Williams AK, Richardson MG. Expecting the unexpected: perspectives on stillbirth and late termination of pregnancy for fetal anomalies // Anesth. Analg. 2015. Vol. 121. No. 2. P. 457−464. DOI: 10.1213/ANE.0000000000000785

[23] Benute GR, Nomura RM, Liao AW, et al. Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. Midwifery. 2012;28(4):472−475. DOI: 10.1016/j.midw.2011.06.011

[24] Benute G.R., Nomura R.M., Liao A.W. et al. Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation // Midwifery. 2012. Vol. 28. No. 4. P. 472−475. DOI: 10.1016/j.midw.2011.06.011

[25] Govender L, Ndjapa-Ndamkou C, Aldous C, Moodley J. A pilot study of women’s experiences after being offered late termination of pregnancy for severe fetal anomaly. Niger J Clin Pract. 2015;18 Suppl:S71−S76. DOI: 10.4103/1119-3077.170825

[26] Govender L., Ndjapa-Ndamkou C., Aldous C., Moodley J. A pilot study of women’s experiences after being offered late termination of pregnancy for severe fetal anomaly // Niger. J. Clin. Pract. 2015. Vol. 18. Suppl. P. S71−S76. DOI: 10.4103/1119-3077.170825

[27] Korenromp MJ, Page-Christiaens GC, van den Bout J, et al. Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol. 2007;196(2):149.e1−11. DOI: 10.1016/j.ajog.2006.09.013

[28] Korenromp M.J., Page-Christiaens G.C., van den Bout J. et al. Maternal decision to terminate pregnancy in case of Down syndrome // Am. J. Obstet. Gynecol. 2007. Vol. 196. No. 2. P. 149.e1−11. DOI: 10.1016/j.ajog.2006.09.013

[29] Seligman M, Darling RB. Obychnye sem’i, osobye deti. Moscow: Terevinf; 2013.

[30] Селигман М., Дарлинг Р.Б. Обычные семьи, особые дети. Москва: Теревинф, 2013.

[31] Fay V, Thomas S, Slade P. Maternal-fetal medicine specialists’ experiences of conducting feticide as part of termination of pregnancy: a qualitative study. Prenat Diagn. 2016;36(1):92−99. DOI: 10.1002/pd.4720

[32] Fay V., Thomas S., Slade P. Maternal-fetal medicine specialists’ experiences of conducting feticide as part of termination of pregnancy: a qualitative study // Prenat. Diagn. 2016. Vol. 36. No. 1. P. 92−99. DOI: 10.1002/pd.4720

[33] Mikhaylov AV, Zamanaeva YuV. Psikhologiya perezhivaniya antenatal’nykh poter’. In: Plod i novorozhdennyy kak patsienty. Saint Petersburg: Petropolis; 2015. P. 696−703. (In Russ.)

[34] Михайлов А.В., Заманаева Ю.В. Психология переживания антенатальных потерь // Плод и новорожденный как пациенты. Санкт-Петербург: Петрополис, 2015. C. 696−703.

[35] Korenromp MJ, Page-Christiaens GC, van den Bout J, et al. Adjustment to termination of pregnancy for fetal anomaly: a longitudinal study in women at 4, 8, and 16 months. Am J Obstet Gynecol. 2009;201(2):160−167. DOI: 10.1016/j.ajog.2009.04.007

[36] Korenromp M.J., Page-Christiaens G.C., van den Bout J. et al. Adjustment to termination of pregnancy for fetal anomaly: a longitudinal study in women at 4, 8, and 16 months // Am. J. Obstet. Gynecol. 2009. Vol. 201. No. 2. P. 160−167. DOI: 10.1016/j.ajog.2009.04.007

[37] Elder SH, Laurence KM. The impact of supportive intervention after second trimester termination of pregnancy for fetal abnormality. Prenat Diagn. 1991;11(1):47−54. DOI: 10.1002/pd.1970110109

[38] Elder S.H., Laurence K.M. The impact of supportive intervention after second trimester termination of pregnancy for fetal abnormality // Prenat. Diagn. 1991. Vol. 11. No. 1. P. 47−54. DOI: 10.1002/pd.1970110109

[39] Nazaré B, Fonseca A, Canavarro MC. Trauma following termination of pregnancy for fetal abnormality: is this the path from guilt to grief? Journal of Loss and Trauma. 2014;19(3):244−261. DOI: 10.1080/15325024.2012.743335

[40] Nazaré B., Fonseca A, Canavarro M.C. Trauma following termination of pregnancy for fetal abnormality: is this the path from guilt to grief? // Journal of Loss and Trauma. 2014. Vol. 19. No. 3. P. 244−261. DOI: 10.1080/15325024.2012.743335

[41] Dobryakov IV, Blokh ME, Faerberg LM. Perinatal loss: psychological aspects, the specificity of mourning, forms of psychological help. Journal of obstetrics and women’s diseases. 2015;64(3):4−10. (In Russ.). DOI: 10.17816/JOWD6434-10

[42] Добряков И.В., Блох М.Е., Фаерберг Л.М. Перинатальные утраты: психологические аспекты, специфика горевания, формы психологической помощи // Журнал акушерства и женских болезней. 2015. Т. 64. № 3. C. 4−10. DOI: 10.17816/JOWD6434-10

[43] Kosterina EM. Psikhologicheskoe soprovozhdenie perinatal’nykh poter’. Perinatal’naya psikhologiya i psikhologiya roditel’stva. 2004;(2):94−107. (In Russ.)

[44] Костерина Е.М. Психологическое сопровождение перинатальных потерь // Перинатальная психология и психология родительства. 2004. № 2. С. 94−107.

RIGHTS & PERMISSIONS

Eсо-Vector